Airway recommendations for perioperative patients during the COVID-19 pandemic: a scoping review

Grudzinski, A.; Sun, B.; Zhang, M.; Crnic, A.; Djokhdem, A. H.; Hanna, M.; Montroy, J.; Duggan, L. V.; Hamilton, G. M.; Fergusson, D. A.; Boet, S.; McIsaac, D. I.; Lalu, M. M.

Purpose: Numerous guideline recommendations for airway and perioperative management during the COVID-19 pandemic have been published. We identified, synthesized, and compared guidelines intended for anesthesiologists. Source: Member society websites of the World Federation of Societies of Anesthesiologists and the European Society of Anesthesiologists were searched. Recommendations focused on perioperative airway management of patients with proven or potential COVID-19 disease were included. Accelerated screening was used; data extraction was performed by one reviewer and verified by a second. Data was organized into themes based on perioperative phase of care. Principal Findings: Thirty unique sets of recommendations were identified. None reported methods for systematically searching or selecting evidence to be included. Four were updated following initial publication. For induction and airway management, most recommended minimizing personnel and having the most experienced anesthesiologist perform tracheal intubation. Significant congruence was observed amongst recommendations that discussed personal protective equipment. Of those that discussed tracheal intubation methods, most (96%) recommended video laryngoscopy, while discordance existed regarding use of flexible bronchoscopy. Intraoperatively, 23% suggested specific anesthesia techniques and most (63%) recommended a specific operating room for patients with COVID-19. Postoperatively, a minority discussed extubation procedures (33%), or care in the recovery room (40%). Non-technical considerations were discussed in 27% and psychological support for healthcare providers in 10%. Conclusion: Recommendations for perioperative airway management of patients with COVID-19 overlap to a large extent. However, we also identified significant differences. This may reflect the absence of a coordinated response towards studying and establishing best-practices in perioperative patients with COVID-19. Registration: Open Science Framework (https://osf.io/a2k4u/)